HomeMy WebLinkAboutPermit Septic Tank 1981-8-28
"'''NSHIP I ~ J RANGE t::?J I SECT~~ J;792:'/ DOU1' Of'
SUBD!\iISION/I-ARTlTIQN ~ale) I 7b'.#-1 B~ g
LOC2ATI~~ ~5:;/?'~, ~~ ~.z;::A". y~ ~~ //IP PROPOSED USL ur Pk0f-ERTY
ST~S~G"~Iu~fd?" ~ . / . .
,~ #41. '/0tr'4 rd"-.
Dl:::::;;I...:?-I,F~F PROP<3 D WV~~ "'/ ../ /' "':/)' $ VALUE
/~-?..q;. "';~) r4u'?''''~ ~#<</..,( co./Jf"4~?'
'. OF'B/'~ "OF S$~ ryf!4;Y~/ I "ATER S"7~~
/~ .~ADD"' ~~JtP ~~/ ~ ~
CONT O~ME a 'S>y/~ 7~ d<<~
~~. d~ d
CDNTRA'ID~JSRlI -I ,9E"-'CTlONS TO ':JP'~ i #' #',. #" ~ /' /' ~ ~.AL,.
/t,.(/p-,/',///7~~k~~~ ~#~~ ~ --2 .</~./4
~;d;e: ~i/---/) ~~..:.:~=<~~" _/.7~p'~/~.4'-/.P~R7
I~4^REIULLY EXAMINED TilE CO~LETED APPLICATION FOR PERMIT, and do h('c"by rtif',' th..1t l11 illf',rf'lltlon h"rc:>on iH~'" dnd :::orn.-f 'wI I furltwr
cert,,~h:t any ilnd all work: pl.l4f'l:)rll",C'd nhall be done in accordance with the Ordil".l'1";T' of L.\nr> COllnty .Iud th,. W''''s of ~h,' 5t ,l-p nf L'f'-'PIl ,--rtHIlin'J
to the work de!!cri.br-d herein, and thtlt NO OCCUPAHCY will be mdde of any ntructur" w1thout thl' pcrni~Lion of the B'Jilding Division. I funtwr c, rtlfy
that r('gintration with the Builder'!! Soard is in full force and effect as requir"'d by ORS 701.0:'':1, thllt if cX€'r.-pt the basis for. x€'l:'.f'tion i'. n'lt..d
hereon, and that only !Jubcontractor!l and employees who are in compliance with ORS 701.0':15 will be us..d on this project. I HAVE READ AND CIIErYSO THI!'
APPLICATION THOROUGHLY.
r
'.
CONSTRufrION/PLACEMENT .
PERM IT
COMPLETE THIS BLOCK.
PLEASE USE BLACK INK AND PRINT.
J:2::t//;I7;t7) I.. h#!6ar-
N~ (please print)
~ht/7ALl!~'
o PLANNING/ZONING: Zone P J:l. Partition' Parcel #
(~ );:_.".'''"'.--3,:,,",. .. C~SidQ .# /'~.te~
~#~~~Jji;~~'::2 .
o FLOODPLAIN: In flood hazard area? ~o DYes, sct." attached shect.
o RURAL ADDRESSING: GRID GOORDINATE N
}if SANITATION: s. 1. # B. P.
FOR OFFICL USE O~~Y
Apolicatiol;<?r-::::;? _t':Y
Permlt #I'.,,~c ) ~~
[]TWO Co~ics of Plans
[]Two Copies of Plot Plans
Dnechanical Checklist
[]plumbin~ Checklist
[JPlan Check Info Sheet
~esidcntial []lndustrial
o Commercial OPublic
o Proposed
&'Existing
TELEPHONL-nDMbER
;?"~ t::fS(j' c;
~er
9/ ~7/iL Dconn.>ctor
/ D~E 0 Agent
Parcel
S'"" /~
rear
Dote, ??-27-c:f'/ W
n
E Date: c=J
# 7~9:--7 / Installation Record Issu~d? 0 YC's D No
Linl!al Fr.oct
of Orainficld
AUTHORIZED BY THIS PERMIT
Sq. Ft.
Fixed Fee/
Unit Cost
Date:
?411
,
,^
Date:
n
~. --
Floodplain Fee
Subsurface Fees
Building Fee
Sewer/Storm Drain/Water
Plumbing Fixtures
Mechanical
Plans Check Fee
State Surcharge
FEES PAID BY:~Ck) ~%
:::e: /~!n-r/
?'XllzlJ Q7
DA~E
AVENUE, EUG ,OREGON 97401
TOTAL FEE
/
TOTAL VALUATION
$
,/hwuJ ~, yMdJ.~OO1d
- PERMIT APPOO 0 BY 8 LDING OF ICIAL/DESIGNEE (per ORS 456.805(1))
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT / 125 EAST EIGHTH
C74-194 ~\LG~ ~ VL~~o1
$
$~~
$
$
$
$
$
S
s~~'=
~7"
,
SETBACKS AND OTHER CDNDITIONS OF APPROVA~ST BE STRICTLY OBSERVED. VIDLATION CAN ~LT IN REVOCATION OF THIS PERMIT:
CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND lOR OTHER REMEDIES ALLOWED BY LAW.
WHEN READY FOR INSPECTION CALL 687-4065. A MINIMUM OF AT LEAST 24 HOUR ADVANCE NOTICE FOR INSPECTION REQUEST MUST BE
GIVEN. Have the following information ready: Permit number, job address, type of inspection, when it will be ready,
your name and phone number. and any special directions to site.
",
BUILDING DIVISION:
REOUIRED I1ISPECTIONS
1) FOUNDATION INSPECTION: To be made after trenches are excavated and forms erected and when all materials for the foundation
are delivered on the job. Where concrete from a central mixing plant (collJl1only termed II trans it mixed") is to be used,
materials need not be on the job.
2) CONCRETE SLAB OR UNDER-FLOOR INSPECTION: To be made after all in-slab or under-floor building service equipment.
conduit, piping accessories and other ancillary equipment items are in place but before any concrete is poured
or floor sheathing installed, including the subf100r.
3) FRAMING & INSULATION INSPECTIONS: To be made after the roof, all framing, fire blocking and bracing are in place and
all pipes, fireplaces and chimneys and vents are complete and all rough electrical and plumbing are approved. All
wall insulation and vapor barrier are in place.
4) LATH AND/OR GYPSUM BOARD INSPECTION: To be made after all lathing and gypsum board, interior and exterior, is in place
but before any plastering is applied or before gypsum board joints and fasteners are taped and finished.
5) FINAL INSPECTION: To be made after the building is complete and before occupancy.
APPROVAL REQUIRED. No work shall be done on any part of the building or structure beyond the point indicated in each
successive inspection without first obtaining the approval of the building official. Such approval shall be given only
after an inspection shall have been made of each successive step in the construction as indicated by each of the inspections
requi red.
NOTE: All building permits require inspections for the work authorized, such as but not limited to:
A. 8LOCK WALL: To be made after reinforcing is in place, but before any grout is poured. This inspection is
required for each bond beam pour. There will be no approval until the plumbing and electrical inspections
have been made and approved.
B. WOOD STOVE: To be made after completion of ma_onrv (if applicable) and when installation is comolete.
Installation sha 11 be in accordance with an approved nationally recognized testlng agency .rld the manu-
facturer's installation instructions.
C. MOBILE HOME: An inspection is required after the mobile home is connected to an approved sewer or septic
system for: setback requirements, blocking, footing connection, tiedowns, skirting, and plumbing
connections.
(1) Footings and piers to comply with State foundation requirements for mobile homes or as recomnended
by the manufacturer.
(2) Mobile home minimum finish floor elevation shall be certified when required by a floodplain
management letter.
(3) Mobile home tiedowns, when required, and skirting shall be installed and ready for inspection
within at least 30 days after occupancy. Tiedowns and skirting shall be installed per enclosure.
D. SWIMMING PDDL: Below grade when steel is in place and before concrete is poured. Above grade when pool
is installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT WILL EXPIRE IF WORK DOES NDT BEGIN
WITHIN 180 DAYS, OR IF WORK IS SUSPENDED DR ABANDONED' FOR MORE THAN 180 DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS
PER~IIT WAS ISSUED ON THE BASIS OF INCGrIPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST THE PDINT OF REQUIRED INSPECTIONS WILL 00 SO AT HIS OWN RISK
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS
(1)
(2)
Permits shall be effective for one year from the date of issuance.
Upon completing the construction for which a permit has been issued the permit holder shall notify the
Department by submitting the installation record form. The Oepartment shall inspect the construction to
determine if it complies with the rules contained in this division. If the construction does comply with
such rules, the Department shall issue a certificate of satisfactory completion, to the permit holder. If ~he
construction does not comply with such rules, the Department shall notify the permit holder and shall requlre
satisfactory completion before issuing the certificate. Failure to meet the requirements for satisfactory
completion within a reasonable,time constitutes a violation of ORS 454.605 to 454.745 and this rule.
Setbacks - Subsurface Sewaoe Disposal
"
From: Interior property lines
Edge of road right-of-way
Building foundation
Wells, other water sources
Seotic Tank
10'
10'
5'
50'
Drainfield
10'
10'
10'
100'
..
,t
/ ..
. .a. Environmental Management
. ACT~TYINFORMATI01'W'HEET
THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
kJne county
~
COMPLETE
(iJ
.Sc....,.,...c......
APPLICANT/REPRESENTATIVE
~~rd L.. 5.6-e,.+
PROPERTY OWNER/CONTRACT PURCHASER
").or " 1>4 f I e..kJ
1 6'i'l/
l~/- (>-S~ (,
BUSINESS TELEPHONE NUMBER
s'" ,., 'O!:-.
W.ILING ADDRESS
7'1~
S... ..M '4L.
CITY
STATE
ZIP CODE
5~....._
BUSINESS TELEPHONE NUMBER
S~__L-
HOME TELEPHONE NUMBER
~ APPLICANT /REPRESENTl\TIVE
'f)otr i s
MAILING ADDRESS
eJre.....
~'JJf71
ZIP CODE
STATE
/'1 / ~ 6 'Si 6
HOME TELEPHONE NUMBER
@ MAIL INFORHATION TO:
o PROPERTY OI'1NER/CONTRACT PURCHASER
G> TAX MAP/PROPERTY DESCRIPTION NUMBER (from tax maps
Tax Map Number: /? '- 3 - ~ _ -.J_ ..-J
in Department of Assessment & Taxation or from tax statement):
Tax Lot (5) :
o Out of TL #
Tax map number of adjoining property in same ownership: o NOl!e
Tax Map Number:
Tax Lot (5) :.
@ SUBDIVISION (if ap9!icable):
@ REQUEST (briefly describe informatiOn?ded): ./Ill P A ;.,
/ n ~--d- uJ
. ,
/7EJ/
By partition f!:
D Unknown
BLOCK:
LOT:
_ t/Af /iJ~ sol:)
COMPLETE THIS SECTION FOR LAN~USE.
CONSTRUCTION APPLICATIONS. OR PROPOSALS. SEE "NOTE BELOW.
~ TOTAL CONTIGUOUS PROPERTY IN SAME OtfflERSHIP:
acres
~ PROPERTY ADDRESS: :?~$ (;b rtl "\
~C;- Lu..,...-P;r,,/d A "e _
,. ,
Q) PRESENT USE OF PROPERTY: #6'_ oC-
@NUMBER OF STRUCTURES ON 'PROPERTY: Standard home~ Mobile home
Modular home
RV in use as residence
Storage_
Garage_
Shop_
Barn
Other (specify)
@ ACCESS TO PROPERTY:
"aw- ;5
.~ of ___ +
Public Road Name
Private Road Name
Road Easement
Width
i of
Users
@ OTHER EASEMENTS OVER PROPERTY:
~t7;r L
(]) "^1'EH .OIS'!'RICT: _W~J I
@ FIRE DISTRICT: ~..., /~
...4-lt-~_
G EXISTING PERt-lITS ON PROPERTY:
7/81
1ifi ,7t'
**FOR STAFF USE ONLY**
6ro
NUMBER:
DATE: J/2j
TIME INITIATED:I(): c::h
CHECKED BY: ~
ATTACHED EXHIBITS:
0-]
~
......
0-]
t"
o Plot Plans (2)
o Constr. plans (2)
o Si te
o Copy
o Other
Plan
of Tax Map
SCREENING VERIFICATION:
By:
Date:
Time In:
Out:
o Accept 0 Reject
Routed to:
*NOTE:
ATTACH A COPY OF TAX MAP;
SHOWN EXISTING STRUCTURES
AND TAX LOTS IN YOUR OWN-
. ERSHIP. OBTAIN TAX MAP
IN SELF HELP AREA.
COMPLETE THIS SECTION FOR LAN~SE
~ PROPOSED USE OF PROPERTY IN DETAIL:
ONLY*'"
ZONE/LAND USE:
By:
-,
Date:
Time Ih:
Out:
~ BUILDING REQUESTS :
contractor's #
(for mobile home setup also)
D Accept 0 Reject
o Plannfng Application
D Construction Perroi t App.
o Information Only
Directions to Site:
Zoning:
Compo Plan Designation:
Check the type of permit requested:
Comments:
o Dwelling: D New
o Replacement
o Addi tional;
.
o Addi tion 0 Al teration;
o Modular Home 0 M"obile Home - Model
Year
DRV
D Standard Construction;
o Plan Check Only
o CQmmercial: Use
Floor Area
SANITATION:
o ~gricut-tural: Use
o Others: Use
By:
.'
Floor Area
Date:
o Change of Use - How?
Time In:
Out:
,
@ SANITi\TION REQUESTS:
[J,Site evaluation for 50S feasibility
o N~w system installation
~/rePlacement
tJ Alteration/relocation
D Hook to existing
o Accept 0 Reject
[] Constr. Permit Issue
o Site Evaluation Issue
PERMIT ISSUED (SAME DAY ONLY) :
Permit #
By:
Date:
ADDITIONAL INFORMATION:
Time In:
Out:
,
TRS, TT
.Plat
Subdivision
Lot
.
.
Plan
Block
Vicinity Map
C74,:lSO
r--
.
N
Job Location
Permit II
Permit II
Permit II
----------
\N~\\"'
o
Ie
(Address)
For
For
For
Permit II
Permit n
Permit II
tJ{)rr;~ $10
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COUNTY DEf"T ENV MGT l'a:CEIPT ':~ 1 B~>3B1 DATE OBi.',
ADDR 745 DORRIS, SPRINGFIELD, OREGON ,
LOT BLI<
0') NO UNITS 001 NO STORIES NO BLDGS 00'l..
SQ FT UNIT COST VALUATION FEE D~S
LANE
EDWAr~D
SUBDIV
USE '1'<' NO BImMS
ACTION DESCRIPTION
APPLICANT GABERT,
TLt 1B03022001901
NEI,J BLDG TYPE
CODE APF'L NO
BP
Elf"
BF'
BF'
. BF'
BF'
.
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PL
.
MECH
StJl'~
PCI(
SDS
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. CATG:
SEQtJ:
TAKEN
.
.
NO" FIXTURES:
LC 1B53B1 SDSR
API"
o
BY RI...H
F(A
FP
EST.
CONNECTOF(S:
MECHANICAL F'EE
STIHE StJF(CHAr~GE
PLAN CHECI< FEE
NO.
.
15.00 EACH ""
.
./
.:
4%
50%
...c
.,ci
l:-
e;::
t.t
at
I~
25...00
SDS
1
COMPL.ETION DATE
SI
PCI<
OTH
ISS
2
090481
TOTAL FEE**
25..0{.)
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